Becoming an Ex-Forensic Psychiatric Client: Transitioning to Recovery within the Community

Abstract

This study used Constructivist Grounded Theory to explore both how clients within a forensic psychiatric service in Aotearoa/New Zealand transitioned to living in the community and what factors influenced this transition. The method involved six client participants, aged between their late 20s and mid-40s and eight staff participants aged mid-20s to late 50s completing a total of nineteen semi-structured intensive interviews and five walking interviews. A notable feature of the client participants’ accounts was their poverty of speech. The staff participants augmented and triangulated the client participants’ rich but abbreviated stories. Together, the clients and staff provide insights into the non-linear return of autonomy, which eventually leads to recovery within the wider community. Two major themes developed. First, the transition process was controlled by an elaborate rule-bound apparatus, which was dictated by the label of Special Patient. A second theme revealed how those clients transitioning strived to regain their autonomy during this often-turbulent process. Transition to the community was dependent upon several wellness factors: how they viewed themselves and if they found acceptance in the community. Three distinct stages emerged within a successful transition: 1) Being Well, 2) Becoming an Ex, and 3) Belonging in the Community. The key to facilitating success was the engagement in activities that developed new identities or changed roles by connecting to the community. Making connections took focused and concerted work by the client, and the staff, allowing the client to make conscious choices about their future, to look at who they would like to be and to engage with others for the success of the transition. Ironically, a limitation of the study was the poverty of the client’s speech, but that is the challenge of this particular population, marking the work as different from the traditional body of transition literature.